Department of Intensive Care, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
Department of Intensive Care, Faculty of Medicine, Trakya University, Edirne, Turkey.
J Clin Monit Comput. 2021 Aug;35(4):923-929. doi: 10.1007/s10877-021-00707-y. Epub 2021 Apr 20.
This study aimed to evaluate the relationship between ultrasonographic gastric antral measurements and aspirated gastric residual volume (GRV) in mechanically ventilated critically ill patients receiving enteral nutrition (EN). This prospective observational study included 56 enterally-fed critically ill patients in one-year period. All imaging procedures were done at 30-degree head-of-bed elevation and supine position on epigastric region of abdomen with 2.5-6 MHz convex-array probe just before routine GRV aspiration. The antral cross-sectional area (CSA) was calculated by measuring the anteroposterior (dAP) and craniocaudal diameters (dCC) of the gastric antrum. Total 283 ultrasonographic gastric antrum imaging procedures were done. In only eight (2.82%) attempts, the antrum could not be visualized due to inhibition from intra-gastric air or gas in the surrounding intestinal lumen. The calculated mean antral CSA was 568.15 ± 348.37 mm (103.43-2,846.30). The antral CSA correlated significantly with aspirated GRV, and the antral CSA increased linearly with increasing aspirated GRV (R = 0.73, p < 0.0001). In Receiver operating characteristic (ROC) analysis of antral CSA ≥ 920 mm (mean + 1*SD) for estimating aspirated GRV, the area under the curve (AUC) was 0.848 (95% CI, 0.76 ~ 0.93) (p < 0.0001), and ROC analysis of antral CSA to discriminate aspirated GRV ≥ 250 mL showed a significant relation (AUC = 0.969, 95% CI 0.94 ~ 0.99, p < 0.0001). Ultrasonographic measurement of gastric antral CSA is an easy and reliable bedside procedure to estimate GRV in critically ill patients receiving EN in 30-degree head-of-bed elevation and supine position. Trial registration number: NCT04413474, date of registration: June 17, 2020, retrospectively registered.
本研究旨在评估经机械通气的重症患者接受肠内营养（EN）时，超声胃窦测量值与抽吸胃残留量（GRV）之间的关系。这项前瞻性观察研究纳入了一年内 56 例接受肠内喂养的重症患者。所有影像学检查均在床头抬高 30 度和仰卧位时于上腹部进行，使用 2.5-6MHz 凸阵探头，在常规 GRV 抽吸前进行。胃窦横截面积（CSA）通过测量胃窦的前后径（dAP）和颅-尾径（dCC）进行计算。共进行了 283 次超声胃窦成像检查。仅在 8 次（2.82%）尝试中，由于胃内气体或周围肠腔内气体的抑制，无法观察到胃窦。计算得到的平均胃窦 CSA 为 568.15±348.37mm（103.43-2846.30）。胃窦 CSA 与抽吸 GRV 显著相关，且胃窦 CSA 随抽吸 GRV 增加呈线性增加（R=0.73，p<0.0001）。在胃窦 CSA≥920mm（平均值+1*SD）预测抽吸 GRV 的 ROC 分析中，曲线下面积（AUC）为 0.848（95%CI，0.760.93）（p<0.0001），胃窦 CSA 区分抽吸 GRV≥250mL 的 ROC 分析显示出显著相关性（AUC=0.969，95%CI 0.940.99，p<0.0001）。在床头抬高 30 度和仰卧位的情况下，超声胃窦 CSA 的测量是一种简单可靠的床边操作方法，可用于估计接受 EN 的重症患者的 GRV。试验注册号：NCT04413474，登记日期：2020 年 6 月 17 日，回顾性登记。
